Texas Health Resources is implementing an electronic health record solution across its 14 acute-care hospitals with over 3,100 beds, 18,000+ employees and 3,600 primarily independent community-based physicians; hospital-based clinics and physician practices.
Texas Health implemented a Value Model program, focused on achieving benefits from this significant investment. Drivers for developing a Value Model include:
Understanding how EHR value is produced allows us to engineer that value, instead of just focusing on technical implementation.
Quantitative benefit metrics allow us to make course corrections if anticipated benefits are not received in a timely manner.
Proving that the EHR has delivered the promised value creates a sense of achievement and closure, motivates system use and improves morale.
Well-defined goals for benefit realization align and motivate organizational leadership, clinicians and staff in a way that technical goals do not.
Texas Health identified 16 benefit areas around four categories: improved quality/safety, efficiency, satisfaction and financial savings.
How HIT is being used to improve patient care or delivery. The EHR coupled with value model research is driving improved nursing efficiencies. Time savings goals were established for Med-Surg and ICU areas. Activities measured centered around charting, accessing information and medication administration reconciliation. Observations and time studies were used.
Improvements were realized in three out of four areas over baseline. This research indicated a post-EHR productivity decrease in the ICU. Root cause analysis indicated that lack of medical-device integration is causing ICU nurses to enter the information in the system rather than simply filing the device printouts on the paper chart. This type of research is critical to ensure ongoing investments in enhancements and interfaces to continue the improved efficacy of an EHR.
The chart below demonstrates Year 1 results across all metrics for one of our hospitals. Over 70% of categories reached performance targets. One area achieving performance targets is adverse drug events (IHI Trigger Tool)—and three areas where targets were not met but Texas Health greatly learned from the measurement.
- ED: Wrong metrics (new metrics—triage to bed, seen by physician).
- HIM: Navigating in the chart (won’t reach until paper is gone; focus design and training on chart review and abstraction process).
- Medication costs: While the system can improve formulary compliance and recommend evidence-based therapies, we are also dealing with the changing of drugs over time, increasing cost of drugs over time and such variables as increased usage of MRSA antibiotic therapies.
Valuable insights are gained from this process even if goals weren’t fully achieved.
In seeking American Recovery and Reinvention Act of 2009 funding, nonacademic community based hospitals like Texas Health have a unique opportunity to compete for stimulus funding. We operate on the front lines and can accelerate the pace of change by bringing forth products based in the reality of where the majority of care is delivered. Although lacking the robust infrastructure to secure grants and conduct research of academic hospital systems, we are developing joint grant proposals with university and vendor partners with those strengths. Demonstrated diligence in researching EHR benefits will be critical to successful applications.
